Pushing for IV Push Medications: Cost-Effectiveness Model of Switching from IV Piggyback to IV Push for Frequently Used Emergency Department Medications.

In considering the potential to reduce the carbon footprint of our emergency department (ED) via decreasing plastic waste, we aimed to evaluate the effects of changing certain common emergency department medications from an intravenous (IV) piggyback administration route to IV push. Our team queried hospital pharmacy data to determine the number of doses of several frequently utilized antibiotics administered over a six-month time period, then calculated the resultant cost savings of a switch to IV push. Based upon our modeling calculations, switching certain medication administration routes to IVP can have significant impacts on cost, with an estimated cost savings of about $47,000 every six months. Maximizing the use of push administration could result in even more dramatic cost savings. In some scenarios, using IVP administration results in less than half the amount of plastic waste generated. Future research including a full life-cycle analysis is needed in order to precisely determine the impact on carbon footprint created by making this change.

Randomized double-blind study of the Reliefband as an adjunct to standard antiemetics in patients receiving moderately-high to highly emetogenic chemotherapy.

GOALS: Our goal was to evaluate the efficacy and tolerability of the Reliefband as an adjunct to standard antiemetics in patients receiving moderately-high to highly emetogenic chemotherapy. PATIENTS AND METHODS: Forty-nine adult cancer patients receiving moderately-high or highly emetogenic chemotherapy were randomized to receive either the active Reliefband ( n=26) or an inactive device ( n=23). Patients continued to receive all scheduled and as needed antiemetic agents as prescribed. The device was worn the day of chemotherapy administration for 5 days (days 1-5). Patients maintained a daily dairy of nausea severity, vomiting and retching episodes, and antiemetic medications taken. Each patient completed a Functional Living Index Emesis (FLIE) and a tolerability survey at the conclusion of the study. A Wilcoxon rank sum test was used to compare the number of vomiting episodes, severity of nausea and FLIE scores between the two groups. MAIN RESULTS: Patients wearing the active Relifband experienced less vomiting (Reliefband 1.9 versus inactive device 4.6 mean episodes; p=0.05), retching (1.4 versus 3.6 mean episodes; p=0.05), and nausea severity (0.91 versus 1.65 mean cm/day; p=0.01) over the 5-day period compared to patients wearing the inactive device. Vomiting was statistically significantly reduced during the delayed period (0.42 versus 1; p=0.032), whereas nausea was significantly reduced during the acute (0.71 versus 2.3; p=0.028) and delayed (1.8 versus 3.3; p=0.020) periods. FLIE scores did not differ between the two treatment groups (91 versus 80; p=0.088). CONCLUSIONS: This study suggests that patients receiving moderately-high to highly emetogenic chemotherapy who experience nausea and vomiting despite scheduled antiemetics may benefit from the use of the Reliefband as an adjunct to antiemetics. Limitations of this study include differences in risk factors for emesis, chemotherapy, and antiemetic regimens. A larger, better, controlled randomized study is needed to better define optimal use of this device.